Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage

Dunatov, Siniša; Antončić, Igor; Bralić, Marina; Jurjević, Ante

doi:10.1111/j.1600-0404.2010.01481.x

Cited by 25 publications

(15 citation statements)

References 28 publications

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“…1) [11][12][13][14][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Eight studies were classified as RCTs [14,25,29,30,33,[37][38][39], six as retrospective cohort studies [11,12,28,31,34,35], and five as matched case-control studies [13,26,27,32,36]. The majority of studies focused on IVH in the setting of IPH (68%) compared to SAH (26%), with the remainder including both IPH and SAH patients (5%).…”

Section: Resultsmentioning

confidence: 99%

“…Functional outcome was assessed in eight studies totaling 749 patients [12,14,28,29,32,33,36,38]. GFO did not differ after IVF treatment compared to patients receiving EVD alone with RR 1.41 (95% CI 0.98-2.03), in both fixed-and random-effect models (Fig.…”

Section: Functional Outcomementioning

confidence: 99%

“…To address the complications related to IVH and IVHrelated EVD use, efforts have been made to accelerate the removal of ventricular blood. The intraventricular injection of fibrinolytic agents, referred to as intraventricular fibrinolysis (IVF), in patients suffering from IVH was first described in 1990 [10] and has thus far shown mixed results [11][12][13][14]. The American Heart Association/American Stroke Association guidelines conclude that the efficacy and safety of fibrinolytics in IVH are uncertain [15].…”

Section: Introductionmentioning

confidence: 99%

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Fibrinolytics and Intraventricular Hemorrhage: A Systematic Review and Meta-analysis

et al. 2019

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Intraventricular hemorrhage (IVH) is an independent poor prognostic factor in subarachnoid and intra-parenchymal hemorrhage. The use of intraventricular fibrinolytics (IVF) has long been debated, and its exact effects on outcomes are unknown. A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines to assess the impact of IVF after non-traumatic IVH on mortality, functional outcome, intracranial bleeding, ventriculitis, time until clearance of third and fourth ventricles, obstruction of external ventricular drains (EVD), and shunt dependency. Nineteen studies were included in the meta-analysis, totaling 1020 patients. IVF was associated with lower mortality (relative risk [RR] 0.58; 95% confidence interval [CI] 0.47-0.72), fewer EVD obstructions (RR 0.41; 95% CI 0.22-0.74), and a shorter time until clearance of the ventricles (median difference [MD] − 4.05 days; 95% CI − 5.52 to − 2.57). There was no difference in good functional outcome, RR 1.41 (95% CI 0.98-2.03), or shunt dependency, RR 0.93 (95% CI 0.70-1.22). Correction for publication bias predicted an increased risk of intracranial bleeding, RR 1.67 (95% CI 1.01-2.74) and a lower risk of ventriculitis, RR 0.68 (95% CI 0.45-1.03) in IVH patients treated with IVF. IVF was associated with improved survival, faster clearance of blood from the ventricles and fewer drain obstructions, but further research is warranted to elucidate the effects on ventriculitis, long-term functional outcomes, and re-hemorrhage.

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Section: Resultsmentioning

confidence: 99%

Section: Functional Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fibrinolytics and Intraventricular Hemorrhage: A Systematic Review and Meta-analysis

et al. 2019

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“…206 Another prospective study compared 48 patients with IVH (caused by ICH in 40 [83%]) treated with intraventricular rtPA to 49 matched control patients treated with VC alone. 207 Mortality was reduced from 30% to 10% in the group treated with rtPA, with 2 patients in the rtPA group diagnosed with ventriculitis. In a small prospective trial, 16 patients with IVH and ICH <30 mm 3 were randomized to VC or VC plus urokinase.…”

Section: Strokementioning

confidence: 99%

“…[206][207][208][209][210][211][212][213][214] Retrospective analysis of 42 consecutive patients with IVH, 88% attributable to primary ICH, who were treated with intraventricular urokinase found death occurred in 21 patients (50%) and ventriculitis in 11 (26%). 206 Another prospective study compared 48 patients with IVH (caused by ICH in 40 [83%]) treated with intraventricular rtPA to 49 matched control patients treated with VC alone.…”

Section: Strokementioning

confidence: 99%

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Hemphill¹,

Greenberg²,

Anderson³

et al. 2015

Stroke

2,885

1,196

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2032Purpose-The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. Methods-A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Results-Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions-Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted.These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

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Neurosurgical Emergencies

Lee¹,

Chaichana²,

Huang³

et al. 2020

Current Clinical Neurology

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Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage

Abstract: IVen administration of rt-PA seems to be safe in cases of IVH. This pilot study shows that it may be associated with better outcomes. Further studies and clinical randomized trials are needed to establish indications and IVen administration protocols.

Cited by 25 publications

References 28 publications

Fibrinolytics and Intraventricular Hemorrhage: A Systematic Review and Meta-analysis

Fibrinolytics and Intraventricular Hemorrhage: A Systematic Review and Meta-analysis

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Neurosurgical Emergencies

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